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33 Cards in this Set
- Front
- Back
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2 main types of local anesthetics
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1. Ester
2. Amide |
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Lidocaine
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Amide anesthetic
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Mepivacaine
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a
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Bupivacaine
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a
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Ropivacaine
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a
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Prilocaine
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a
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Procaine
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Ester anesthetic
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Tetracaine
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a
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Cocaine
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a
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Benzocaine
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a
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Local anesthesia
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loss of sensation in body part without loss of consciousness or impairment of central control of vital functions
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Mechanism of action of local anesthetics
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Reversibly block nerve conduction
Inhibit sodium channel activity |
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How pH affect local anesthetics
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Only unionized drug crosses epineurium
Only ionized drug binds to channel Access to pore is from cytoplasmic side |
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Which form of drug crosses the epineurium?
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Unionized form
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Which form of local anesthetic can bind to VG sodium channels?
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Ionized form
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How to access to VG sodium channel pore?
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From cytoplasmic side, therefore drug must be unionized and cross the epineurium first
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Use dependent blockade
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Degree of channel blockade is dependent on activity of nerves
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Local anesthetics preferentially bind which of the following channels: Rest, Activated, Inactivated
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Inactivated channel
Local anesthetics bind and stabilizes the inactive state |
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Local anesthetics block what kind of channels?
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"Fast" VG sodium channels
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Local anesthetics affect which tissues
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All excitable tissues
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Excitable tissues in order of local anesthetic effect
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1. Sensory nerves (nociception)
2. Motor nerves 3. CNS 4. CV 5. Other SM 6. Skeletal muscle |
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Type of fibers carrying nociception
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C fibers and A-delta
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Order of functional block
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1. Pain, Autonomic C-fibers
2. Cold 3. Warmth 4. Touch 5. Deep pressure 6. Motor |
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Order of recovery from functional block
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1. Motor
2. Deep pressure 3. Touch 4. Warmth 5. Cold 6. Pain, Autonomic C-fibers |
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Which fibers (small/large) fibers are more susceptible to local anesthetic blockade?
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Small fibers
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List autonomic fibers in order of susceptibility to local anesthetics
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C, A-delta > A-alpha, A-beta > A-alpha, motor fibers
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List types of nerve fibers in order of susceptibility to local anesthetics:
Important! |
(autonomic fibers) ≥ pain > sensory fibers > motor fibers
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Which types of fibers are most sensitive to local anesthetic block?
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Pain sensations and autonomic C-fibers
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Etidocaine
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Close association b/w sensory anesthesia and motor blockade
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Key property of Bupivacaine (and Ropivacaine) that makes it useful in Ob/Gyn
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Pronounced difference between sensory anesthesia and motor blockade.
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List 4 Amide type local anesthetics
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1. Lidocaine
2. Etidocaine 3. Bupivacaine 4. Mepivacaine |
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List 4 Ester type local anesthetics
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1. Procaine
2. Tetracaine 3. Cocaine 4. Benzocaine |
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Important reaction with ester local anesthetics
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Allergic reactions
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